艾考糊精透析液治疗维持性腹膜透析容量超负荷患者疗效观察

Effect of icodextrin in maintenance peritoneal dialysis volume overload patients

目的 探讨维持性腹膜透析容量超负荷患者应用艾考糊精透析液的效果及安全性。方法 26例维持性腹膜透析[每日交换8~10 L质量分数1.5%或2.5%葡萄糖透析液(2 L/袋)]容量超负荷患者,每日末袋透析液改为质量分数7.5%艾考糊精透析液2 L,留腹12 h,连续应用1周。记录患者透析龄、原发病、腹膜透析方式、腹膜转运特性,应用艾考糊精透析液前、后每日超滤量、每日尿量、血肌酐、血糖等生化指标及皮肤过敏反应、无菌性腹膜炎等不良反应发生情况。结果 26例患者透析龄(28.7±27.5)个月;原发病为原发性肾小球疾病17例,糖尿病肾病6例,高尿酸肾病2例,狼疮性肾炎1例;持续不卧床腹膜透析19例,日间不卧床腹膜透析7例;腹膜高转运5例,高平均转运7例,低平均转运11例,低转运3例;26例患者容量超负荷原因为严重充血性心力衰竭10例,无法耐受的水肿8例,超滤衰竭4例,顽固性高血糖2例,腹膜高转运2例。26例患者应用艾考糊精透析液后每日超滤量[(1 007.69±222.57)mL]多于应用前[(400.00±360.00)mL](t=-13.009,P=0.001),血肌酐水平[(817.65±213.68)μmoL/L]、OH值[(2.14±0.68)L]均低于应用前[(907.73±291.73)μmoL/L、(4.82±1.49)L](t=4.984,P=0.001;t=11.501,P=0.001),血红蛋白、血白蛋白、血钾、血钙、血磷、甲状旁腺激素水平及每日尿量与应用前比较差异均无统计学意义(P>0.05)。6例糖尿病肾病患者应用艾考糊精透析液后空腹血糖水平[(5.86±0.45)mmol/L]低于应用前[(7.84±1.50)mmol/L](t=3.917,P=0.011)。26例患者应用艾考糊精透析液后均未发生皮肤过敏、无菌性腹膜炎等不良反应。结论 艾考糊精透析液可用于容量超负荷的维持性腹膜透析患者;与传统葡萄糖透析液相比,维持性腹膜透析患者应用艾考糊精透析液后超滤量增多,透析充分,糖尿病肾病患者血糖改善。

Objective To investigate the clinical effect and safety of icodextrin in maintenance peritoneal dialysis volume overload patients.Methods Twenty-six patients with maintenance peritoneal dialysis volume overload(exchanging8-10 L of 1.5% or 2.5% glucose dialysate daily) were treated with 6-8 L of 1.5% or 2.5% glucose dialysate followed by2 L of 7.5% icodextrin in peritoneum for 12 h at the end of each day for one week.The dialysis age,primary diseases,peritoneal dialysis method and peritoneal transport characteristics were recorded.The daily ultrafiltration volume,daily urine volume,serum creatinine,plasma glucose and other biochemical parameters before and after the use of icodextrin,as well as the adverse reactions such as skin allergies and aseptic peritonitis were recorded.Results The dialysis age of 26patients was(28.7 ± 27.5) months.The primary diseases were primary glomerular disease in 17 patients,diabetic nephropathy in 6,hyperuricemic nephropathy in 2,and lupus nephritis in 1.Nineteen patients received continuous ambulatory peritoneal dialysis and 7 received daytime ambulatory peritoneal dialysis.There were 5 patients with high peritoneal transport status,7 with high-average transport,11 with low-average transport,and 3 with low transport.The causes of volume overload were severe congestive heart failure in 10 patients,intolerable edema in 8,ultrafiltration failure in 4,refractory hyperglycemia in 2,and high peritoneal transport status in 2.The daily ultrafiltration volume was higher in 26 patients after using icodextrin [(1 007.69 ± 222.57) mL] than that before using [(400.00 ± 360.00) mL](t=-13.009,P=0.001),the serum creatinine level and overhydration value were lower after using icodextrin[(817.65±213.68)μmoL/L,(2.14±0.68) L] than those before using [(907.73±291.73) μmoL/L,(4.82±1.49) L](t=4.984,P=0.001;t=11.501,P=0.001),and the hemoglobin,blood albumin,blood potassium,blood calcium,blood phosphorus,parathyroid hormone and daily urine output showed no significant differences(P>0.05),The fasting plasma glucose level was lower after using icodextrin [(5.86±0.45) mmol/L] than that before using [(7.84±1.50) mmol/L] in 6 patients with diabetic nephropathy(t=3.917,P=0.011).No adverse reactions such as skin allergies or aseptic peritonitis occurred in 26 patients after using icodextrin.Conclusions Icodextrin can be used in maintenance peritoneal dialysis volume overload patients.Compared with traditional glucose dialysate,icodextrin can increase ultrafiltration volume and ensure adequate dialysis in patients undergoing maintenance peritoneal dialysis,and can control the plasma glucose in patients with diabetic nephropathy.